AMA Replace covers a variety of well being care subjects affecting the lives of physicians, residents, medical college students and sufferers. From personal follow and well being system leaders to scientists and public well being officers, hear from the specialists in medication on COVID-19, medical training, advocacy points, burnout, vaccines and extra.
Questioning keep away from COVID this vacation season? AMA’s Vice President of Science, Medication and Public Well being, Andrea Garcia, JD, MPH, breaks down the perfect time to get vaccinated and offers updates on the newest COVID variant and the surge in RSV and flu instances. Plus, the sharp lower in vaccination charges amongst kids and the alarming improve in syphilis infections in newborns. AMA Chief Expertise Officer Todd Unger hosts.
- Andrea Garcia, JD, MPH, vice chairman, science, medication & public well being, American Medical Affiliation
Unger: Good day and welcome to the AMA Replace video and podcast. As we speak we now have our weekly have a look at the headlines with the AMA’s Vice President of Science, Medication and Public Well being, Andrea Garcia in Chicago. I am Todd Unger, AMA’s chief expertise officer additionally in Chicago. Welcome again, Andrea.
Garcia: Hello, Todd. It is good to see you. Thanks for having me.
Unger: Nicely, we’re about to go into the large Thanksgiving vacation week. And it is one of many busiest journey durations all yr. The CDC introduced that it will likely be conducting extra monitoring in any respect main airports. Andrea, inform us extra about that and what it will imply for vacationers.
Garcia: Yeah. So this extra monitoring is being performed via the CDC’s Journey-based Genomic Surveillance Program or TGS and that started throughout the pandemic. And it acted actually as an early warning system to detect new COVID variants. That program actually consists of a few totally different approaches.
Considered one of them is voluntary nasal sampling of arriving worldwide vacationers. There’s airport iterator drain sampling. After which airplane wastewater sampling. Based on the CDC, that TGS program has been remarkably efficient at detecting many variants coming into the U.S. as much as six weeks earlier than they’ve even formally been reported nationwide. Earlier this month the company stated that they are increasing a pilot program and that is going to incorporate testing for flu, RSV and different respiratory viruses.
Unger: Good work, CDC. Andrea, inform us extra about how the pilot growth goes to work.
Garcia: Yeah. So we all know that there are seven worldwide airports that take part within the COVID surveillance efforts. Below the pilot, TGS goes to be increasing to check for greater than 30 micro organism antimicrobial targets and viruses. And that is particular to 4 airports, so Boston, San Francisco, Washington Dulles and JFK in New York. The pilot goes to final for a number of months. And it is time to come forward of the winter months after we know these respiratory viruses are circulating extra closely. CDC says that this expanded program might doubtlessly assist stop tens of 1000’s of infections.
Unger: Wow. That could be very sensible. Andrea, you stated expanded testing and monitoring. Let’s discuss how we transcend that. We all know that vaccines are additionally one other large software right here within the armament. What does the CDC say about getting vaccinated forward of the vacations?
Garcia: Yeah. So in an interview with CBS Information I feel it was a couple of week in the past Dr. Mandy Cohen, who we all know is the director of the CDC, stated that finest window to get vaccinated to guard your self and your loved ones earlier than any gathering is about two weeks out, as a result of we all know it takes 1 to 2 weeks for COVID and flu vaccines to spice up immunity. Nonetheless, given the place we are actually, we all know we’re simply days away from Thanksgiving. It is vital to take into account that it is by no means too late to get vaccinated and guarded in opposition to these respiratory viruses, which we all know may cause extreme sickness and even loss of life in some populations.
As we have talked about earlier than, the CDC expects to see flu, COVID and RSV circulating on the similar time this season. We all know that top vaccination ranges will help reduce the severity and affect of those illnesses. And this yr we’re fortunate as a result of we do have vaccines obtainable for all three viruses for the primary time ever. Sadly, we nonetheless have a methods to go to achieve these excessive vaccination ranges.
Unger: Andrea, final time we talked we hadn’t seen a major rise in RSV, COVID or the flu but. Is that also the case?
Garcia: Nicely, based on the flu evaluate put out by CDC most just lately we all know that flu exercise is now growing in most components of the nation. That is most noticeable in South Central, the Southwest and the West Coast areas. We additionally know that RSV and COVID instances are growing in some jurisdictions.
We’ve got a brand new COVID variant known as HV.1 that we do have to control. It is simply been a number of brief weeks and HV.1 has turn into the variant chargeable for most COVID instances right here within the U.S. As a reminder, CDC recommends that everybody six months and older get that up to date COVID vaccine and this yr’s seasonal flu vaccine. And a typical query is can they be administered collectively? And the reply to that’s completely, sure they’ll.
Unger: Andrea, one of many issues we have talked about over the previous few weeks is simply total low vaccination charges. And one of many causes that underlies that has been sort of a rocky rollout that we skilled with the up to date COVID shot and provide shortages that we bumped into with the RSV vaccine. Any updates there by way of how that is been going?
Garcia: Yeah. There was some excellent news for folks who we all know have been making an attempt to guard their infants in opposition to RSV. Final week, we heard the CDC announce the discharge of greater than 77,000 extra doses of Beyfortus, that is that long-acting monoclonal antibody that’s designed to guard infants from extreme RSV illness.
These extra doses are going to be distributed instantly to physicians and hospitals via each the VFC program and industrial channels. That ought to assist enhance availability of the shot for eligible infants, significantly these vulnerable to extreme sickness. CDC and FDA have stated that they will proceed to be in shut contact with the producers to assist guarantee the provision of extra doses via the top of this yr and into early 2024 to try to meet that demand. CDC is asking physicians to prioritize these doses for these infants that we all know are at highest danger throughout this era of constrained provide.
That features younger infants as much as six months and American Indian Alaska native infants amongst different teams. And on the similar time, CDC and FDA are additionally encouraging physicians to make use of that RSV maternal vaccine, which isn’t dealing with those self same provide challenges because the monoclonal antibody, that may assist defend infants in opposition to RSV earlier than they’re born.
Unger: All proper. Nicely, staying on the subject of kids and vaccines, a brand new report got here out that offered perception on total vaccination charges amongst kids. Andrea, what are the important thing takeaways there?
Garcia: Nicely, Todd, it isn’t significantly excellent news. Based on a latest report from the CDC, the childhood vaccine exemption price, that is the variety of youngsters who aren’t getting their routine childhood vaccines, has reached an all-time excessive. That report particularly checked out kindergartners whose dad and mom or caregivers have opted them out of vaccines.
And CDC discovered that as a nationwide common 3% of kids coming into kindergarten within the 2022-2023 college yr have been granted a vaccine exemption from their state. That is the best vaccine exemption report ever reported within the U.S. 41 states noticed an increase in exemption in 10 states together with Arizona, Hawaii, Michigan, Nevada and Wisconsin, that exemption price was over 5%. And Idaho had the best exemption price with greater than 12% of kids coming into kindergarten with a vaccine exemption in 2022. CDC signifies that exemption charges over 5% improve that danger for outbreaks of vaccine preventable illnesses like measles, mumps, and polio.
Unger: These are actually regarding statistics. Andrea, do we now have any concept why that is taking place?
Garcia: Nicely, this particular report didn’t go into the explanations for that improve in exemptions. Given this, it is probably not clear whether or not they replicate a real improve in opposition to the vaccine, vaccine hesitancy or if dad and mom are asking for non-medical exemptions due to limitations to vaccination or if there are even different components concerned. I feel CDC is making an attempt to get a greater understanding of the explanations at play so it might use that data to tell coverage that may assist improve vaccination charges and cease a reoccurrence of illnesses that we all know are preventable.
Unger: Talking of preventable illnesses, syphilis has been making headlines. Nonetheless, it isn’t in the best way that you’d suppose. It is affecting newborns. Andrea, what is going on on there?
Garcia: There was an alarming improve in syphilis infections in newborns. When a pregnant particular person with syphilis passes the an infection to the newborn throughout being pregnant, we all know that is known as congenital syphilis. Based on a CDC report, greater than 3,700 infants have been born with syphilis within the U.S. in 2022. That is a 32% improve from the yr earlier than and a 1,000% improve from 2012.
Syphilis, if left untreated in a pregnant particular person, can have devastating penalties for the newborn. Infants born with congenital syphilis in 2022, about 300 of them died or have been stillborn. Along with stillbirth, we all know that untreated syphilis can harm the newborn’s organs and bones and hurt imaginative and prescient and listening to, which we all know can result in lifelong well being issues.
Unger: Andrea, any concept why that is taking place now?
Garcia: We all know that every congenital syphilis case is taken into account a by no means occasion. It is a tragic final result that ought to by no means occur as a result of it is almost at all times preventable if it is caught and handled in time. Based on the CDC, new child syphilis happens when people who find themselves pregnant do not obtain that well timed testing and remedy throughout being pregnant. It is a single course of penicillin given no less than a month earlier than the top of being pregnant and that just about at all times prevents contaminated moms from passing the micro organism to their infants.
However the CDC findings present that just about 90% of congenital syphilis instances in 2022 might have been prevented with well timed testing and remedy. Greater than 50% have been amongst individuals who examined constructive for syphilis throughout being pregnant, however they did not obtain that well timed insufficient remedy. 40% have been amongst moms who acquired no prenatal care and that has to vary.
Unger: Andrea, what can physicians do about this explicit downside?
Garcia: So there is a want to essentially concentrate on reaching these at-risk populations and getting them screened and examined. CDC is actually encouraging remedy following a fast syphilis check throughout being pregnant if there’s an opportunity that affected person won’t be obtainable for comply with up care. They’re additionally recommending fast syphilis testing and remedy in locations like emergency departments and syringe service packages, prisons and jails, in addition to maternal and baby well being packages.
There’s an training piece right here that should concentrate on prevention. We have to deal with syphilis earlier than being pregnant in counties the place we all know there are excessive syphilis charges. And we have to proactively display sexually lively girls and their companions who’ve danger components for syphilis. CDC known as this a failure of the U.S. well being system. And I do know that we’re seeing too many people who find themselves not being examined and handled for syphilis.
Unger: And that is undoubtedly one thing we’ll be listening to extra about. Andrea, once more, thanks a lot for becoming a member of us right this moment and sharing these updates. That wraps up right this moment’s episode.
When you loved this dialogue, you’ll be able to help extra programming prefer it by changing into an AMA member at ama-assn.org/be a part of. You could find all our movies and podcasts at ama-assn.org/podcasts. Thanks for becoming a member of right this moment. Please take care.
Disclaimer: The viewpoints expressed on this video are these of the contributors and/or don’t essentially replicate the views and insurance policies of the AMA.